Elbow Replacement Surgery and UCL Reconstruction

Elbow replacement surgery and ulnar collateral ligament (UCL) reconstruction surgery are two distinct procedures addressing different elbow conditions. Both surgeries aim to improve elbow function, but UCL reconstruction focuses on restoring stability for athletes engaged in throwing sports, while elbow replacement surgery aims to reduce pain and enhance function in patients with severe elbow arthritis or joint damage.

In this article, we explore what each surgery is, what the procedure involves, and the benefits. We also examine what you can expect after surgery, the potential risks, and which surgery is right for you.

Elbow Replacement Surgery

Person holding up their arms

Elbow replacement surgery, also known as total elbow arthroplasty, is recommended for patients with severe arthritis, traumatic injuries, or conditions that cause significant pain, loss of motion, and limited function in the elbow joint. During the procedure, we remove the damaged portions of the bones in the elbow joint, including the humerus (upper arm bone), ulna, and sometimes the radius.

We replace the damaged surfaces with artificial implants made of metal and plastic that mimic the natural joint, similar to hip or knee replacement surgeries. The goal is to reduce pain and improve the elbow’s range of motion and function. We secure the artificial implants in place using specialized surgical techniques and materials. Surgery usually takes one to two hours.

UCL Reconstruction

Commonly known as Tommy John surgery, UCL reconstruction is a procedure that repairs a torn UCL by replacing it with another tendon from elsewhere in the body. This procedure is commonly used to treat UCL instability or tears in athletes who play a throwing sport, such as baseball pitchers who’ve sustained significant UCL damage from repetitive stress.

The UCL, located on the inner side of the elbow, is crucial for stabilizing the joint during throwing motions. When this ligament is injured, it can cause pain, instability, and reduced performance in athletes.

During UCL reconstruction, we typically use a graft from another tendon in the patient’s body, such as the forearm or hamstring, to replace the damaged UCL. We make an incision, remove the torn ligament, drill tunnels in the humerus and ulna bones, and secure the graft in place to reconstruct the UCL. The goal is to restore stability to the elbow joint during overhead throwing motions. The surgery usually takes one to two hours.

Benefits of Elbow Replacement Surgery and UCL Reconstruction

Both surgeries are used to stabilize the elbow, reduce or eradicate pain, and restore the range of motion and stability in the elbow joint. They can also help you regain the ability to perform daily activities and movements.

What To Expect After Surgery

Here’s what you can expect after surgery:

Elbow Replacement Surgery

After surgery, rest and rehabilitation are crucial for how quickly and effectively you recover. You may need to wear a splint or a sling for a few days or weeks after surgery when you’re not exercising. You may also need to use a device called a drain to avoid fluids pooling in your elbow.

Physical therapy plays a significant role in restoring strength, flexibility, and function to the arm. Patients usually undergo a structured rehabilitation program to gradually regain motion and strength in the elbow while allowing the new joint to heal properly. You can usually start moving your elbow joint one or two weeks after surgery. It’s important to note that if you undergo elbow replacement surgery, you must avoid high-impact activities that can cause further injury to the artificial joint, such as hammering, playing contact sports, and lifting heavy weights.

UCL Surgery

Recovery after a UCL reconstruction also involves a comprehensive rehabilitation program. This process focuses on gradually restoring strength, flexibility, and range of motion in the elbow. At the Hand and Wrist Institute, the rehabilitation period is crucial. We use a staged approach to enable the athlete to return to throwing gradually and safely.

You’ll need to wear a brace or splint to protect the surgical site and allow time for healing. We may prescribe medication and icing to help manage pain and swelling during the early stages of recovery. In the first few weeks, we’ll start with gentle exercises to maintain range of motion in the shoulder, wrist, and hand while protecting the elbow. Over the next few months, we’ll work with you to gradually introduce more active physical therapy to regain strength, flexibility, and stability in the elbow.

Potential Risks and Complications

While most elbow replacement and UCL surgeries successfully alleviate pain, there’s a risk that they won’t completely erase it. Even after surgery, you may not fully restore the strength or movement of the joint. Some patients require a second surgery. Potential risks or complications of elbow replacement surgery include:

Which Surgery Is Best For You? 

Choosing between the two surgeries depends on the specific condition, the severity of the injury, your personal goals, and the recommendation of an orthopedic surgeon based on a thorough evaluation. Each procedure has benefits, risks, and considerations, and we tailor our approach to every patient. Our Dallas hand surgeons are skilled at working with athletes to promote a full recovery and restore range of motion in the elbow joint. Contact us to book an appointment today. We can provide a proper diagnosis and personalized treatment plan to ensure proper healing, prevent complications, and safeguard against long-term consequences.


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Dr. John Knight
Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.